Provider Demographics
NPI:1225570880
Name:KELLY O'DONNELL COUNSELING, LLC
Entity Type:Organization
Organization Name:KELLY O'DONNELL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:314-643-8224
Mailing Address - Street 1:456 N NEW BALLAS RD STE 369
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6846
Mailing Address - Country:US
Mailing Address - Phone:314-643-8224
Mailing Address - Fax:
Practice Address - Street 1:456 N NEW BALLAS RD STE 369
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6846
Practice Address - Country:US
Practice Address - Phone:314-643-8224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150397131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty